Childhood Asthma Incidence, Early and Persistent Wheeze, and Neighborhood Socioeconomic Factors in the ECHO/CREW Consortium
Authors: Antonella Zanobetti, Patrick H. Ryan, Brent Coull, Cole Brokamp, Soma Datta, Jeffrey Blossom, Nathan Lothrop, Rachel L. Miller, Paloma I. Beamer, Cynthia M. Visness, Howard Andrews, Leonard B. Bacharier, Tina Hartert, Christine C. Johnson, Dennis Ownby, Gurjit K. Khurana Hershey, Christine Joseph, Song Yiqiang, Eneida A. Mendonça, Daniel J. Jackson, Heike Luttmann-Gibson, Edward M. Zoratti, Anne L. Wright, Fernando D. Martinez, Christine M. Seroogy, James E. Gern, Diane R. Gold, Adam Nunez, Adnan Custovic, Agustin Calatroni, Albert M. Levin, Alex Binder, Alexandra Sitarik, Amanda Cyrus, Amber Spangenberg, Amelia Jones, Amy Dresen, Ana Manuelian, Andrea Cassidy-Bushrow, Andrew Jerrison, Angela Freie, Anne Marie Singh, Anthony Wahlman, Audrey Urquhart, Aviva Lee-Parritz, Benjamin Green, Brenda Patterson, Brent Davidson, Brent F. Olson, Brian Hallmark, Caitlin Suddueth, Camille Johnson, Carin Lamm, Carole Ober, Carolina Jordan, Casper G. Bendixsen, Cathey Strauchman Boyer, Charles Barone, Charlotte Nicholas, Chris Lim, Chris M Reyes, Christopher Sutton, Christopher Tisler, Christopher Wolfe, Christopher G. McKennan, Conner Fleurat, Daniel Nicolae, David Kemp, David Morgan, David Spies, Dean Billheimer, Deanna Cole, Deborah Chasman, Debra A. Stern, Deliang Tang, Dena Scott, Douglas DaSilva, Edlira Gjerasi, Edward Peterson, Elizabeth Anderson, Elizabeth Armagost, Elizabeth Matsui, Elizabeth Tesson, Elsie Parmar, Emily Bull, Eric Schauberger, Erin Donnerbauer, Frank Witter, Frederica Perera, Ganesa Wegienka, George T. O’Connor, Geraldine Birg, Gina Simpson, Gina Crisafi, Gina Stouffer, Gordon Bloomberg, Grace K. LeMasters, Haejin Kim, Heather Floerke, Heidi Erickson, Herman Mitchell, Homer Boushey, Howard Lederman, Hugh Sampson, Irene Ong, Itai Kloog, Jacqueline Jezioro, Jaime Hart, James Wong, Janelle Rivera, Janice Campbell, Jeff Stokes, Jeffrey J. VanWormer, Jeffrey W. Burkle, Jena Tate, Jennifer Martin, Jennifer Meece, Jerel Ezell, Jessica Baucom, Jessica D. Gereige, Jocelyn M. Biagini, Joel Schwartz, John Ainsworth, Jomol Matthew, Judith McCullough, Judyth Ramirez, Julia Bach, Julie Herbstman, Karen Bourgeois, Karen Wells, Katherine Graham McNeil, Katherine Rivera-Spoljaric, Kathrine L. Barnes, Kathryn McCauley, Kathy Roberg, Kevin Bobbitt, Kimberley Woodcroft, Kimberly Ray, Kirsten Carlson-Dakes, Krista Tensing, Kristi Curtsinger, Kristina Keidel, Kristine Grindle, Kylie Riley, Kyra Jones, L. Keoki Williams, Lance Mikus, Laura Ladick, Leanna Farnham, Lisa Gagalis, Lisa Gress, Lisa Salazar, Lisa J. Martin, Liza Murrison, Lori Hoepner, Lydia Lichtiger, Lydia De La Ossa, Lynn Henson, Marcela Pierce, Marcia Jimenez Pescador, Marilyn Halonen, Marina Tuzova, Mark Craven, Mark DeVries, Mary Ann Aubuchon, Matthew Perzanowski, Matthew C. Keifer, Megan T. Sandel, Melissa Yaeger, Meyer Kattan, Michael D. Evans, Michelle Cootauco, Miranda McDonald Stahl, Neisha Rivers, Nicole Gonzalez, Nitsa Whitney, Nonna Akkerman, Paul Jones, Perri Yaniv, Peter James, Philip Couch, Qian Di, Rachel Lisi, Rebecca Brockman-Schneider, Rhoda Sperling, Richard Budrevich, Robert A. Wood, Robert F. Lemanske, Ronald Iverson, Ronald Sorkness, Ronald E. Gangnon, Rony Jose, Rosalind Wright, Rose Vrtis, Ruchika Sangani, Ruth Norris, Samantha Williams, Samantha Fye, Scott Gilhooly, Sharon Hensley Alford, Sharon O’Toole, Shirley Blocki, Shirley Zhang, Silvia Lopez, Stacey Bellemore, Stephanie Leimenstoll, Stephanie Lovinsky-Desir, Stephen Lloyd, Susan Lynch, Susan Doyle, Suzanne Havstad, Sweta Singh, Tammy Kronenwetter Koepel, Tara Johnson, Taylor Groeschen, Tebeb Gebretsadik, Terry Foss, Tressa Pappas, Umberto Tachinardi, Valerie Morgan, Vicki Moon, Victoria Rajamanickam, Victoria Turner, Wayne Frome, Wayne Morgan, Weeberb Requia, William Dupont, William Taylor, William W. Cruikshank, Xinhua Liu, Yury Bochkov, Zachary Flege, Zekai Otles, Zhouwen Liu
Journal: JAMA Pediatrics (2022)

<h3>Importance</h3> In the United States, Black and Hispanic children have higher rates of asthma and asthma-related morbidity compared with White children and disproportionately reside in communities with economic deprivation. <h3>Objective</h3> To determine the extent to which neighborhood-level socioeconomic indicators explain racial and ethnic disparities in childhood wheezing and asthma. <h3>Design, Setting, and Participants</h3> The study population comprised children in birth cohorts located throughout the United States that are part of the Children's Respiratory and Environmental Workgroup consortium. Cox proportional hazard models were used to estimate hazard ratios (HRs) of asthma incidence, and logistic regression was used to estimate odds ratios of early and persistent wheeze prevalence accounting for mother's education, parental asthma, smoking during pregnancy, child's race and ethnicity, sex, and region and decade of birth. <h3>Exposures</h3> Neighborhood-level socioeconomic indicators defined by US census tracts calculated as<i>z</i>scores for multiple tract-level variables relative to the US average linked to participants' birth record address and decade of birth. The parent or caregiver reported the child's race and ethnicity. <h3>Main Outcomes and Measures</h3> Prevalence of early and persistent childhood wheeze and asthma incidence. <h3>Results</h3> Of 5809 children, 46% reported wheezing before age 2 years, and 26% reported persistent wheeze through age 11 years. Asthma prevalence by age 11 years varied by cohort, with an overall median prevalence of 25%. Black children (HR, 1.47; 95% CI, 1.26-1.73) and Hispanic children (HR, 1.29; 95% CI, 1.09-1.53) were at significantly increased risk for asthma incidence compared with White children, with onset occurring earlier in childhood. Children born in tracts with a greater proportion of low-income households, population density, and poverty had increased asthma incidence. Results for early and persistent wheeze were similar. In effect modification analysis, census variables did not significantly modify the association between race and ethnicity and risk for asthma incidence; Black and Hispanic children remained at higher risk for asthma compared with White children across census tracts socioeconomic levels. <h3>Conclusions and Relevance</h3> Adjusting for individual-level characteristics, we observed neighborhood socioeconomic disparities in childhood wheeze and asthma. Black and Hispanic children had more asthma in neighborhoods of all income levels. Neighborhood- and individual-level characteristics and their root causes should be considered as sources of respiratory health inequities.